Fatal cerebral ischaemia by embolization of a gunshot fragment from an extracranial penetrating injury

Demetriades et al report a case of a 30-year-old man who suffered a close range shotgun injury. Despite several right-sided neck wounds, there was no pneumothorax or other cardiorespiratory compromise. CT showed a metal fragment in the right sylvian fissure, but no cranial vault fracture, intracerebral hematoma, pneumocephalus or other signs of parenchymal damage. Neck exploration confirmed a non-exiting penetrating wound in the right common carotid artery, suggesting bullet fragment embolization to the distal intracranial vessels. Post-mortem examination showed a breach of the right carotid sheath and a shrapnel embolus in one of the terminal branches of the ipsilateral middle cerebral artery.